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FNP Review 9
GI signs symptoms constipation
Question | Answer | Rationale |
---|---|---|
symptom or diagnosis where there is decrease in the frequency of stools, excessive difficulty passing stools & straining with defecation | constipation | |
constipation: etiology (general) | functional: most common cause psychogenic, neurologic, metabolic disorders, obstruction, medications | |
constipation: assessment: history | determine pt/family definition of constipation; stool history; current pattern, character,etc; use of laxatives, manual extraction, incontinence; medication, fluid intake, abd/rectal pain, family hx (Hirschsprug's disease), toileting history | |
constipation: assessment: physical exam | VS, growth, weight, distention, tenderness, palpable stool in colon, bowel sounds, rectal exam-sphincter toner, fissures, mass,etc; | |
what do you assess in elderly patient with c/o constipation | signs of fever, delirium, urinary retention, arrhythmias, tachypnea | |
constipation: diagnostic studies | stool for occult blood; CBC ;electrolytes, calcium, BUN, creatinine, glucose; thyroid fxn; flat plate & upright abd film; colonscopy or barium enema | r/o anemia, leukocytosis, colorectal cancer, hyperparathyrodism, hypokalemia, hypercalcemia, uremia; hypothyroidism; obstruction; constipation onset age >40 with |
constipation: differential diagnosis: adult | colon cancer, hemorrhoids, irritable bowel syndrome, obstruction | |
constipation: differential diagnosis: children | Hirschsprung, cerebral palsy, cystic fibrosis, breastfeeding, Down syndrome, obstruction | |
constipation: management: nonpharmacologic treatment for infants | <6 months: continue with formula or breast milk; review formula preparation & fluid intake of breastfeeding mom; 6-12months: continue breastfeeding/present formula; add water between feeding; high fiber food prunes, apricot | |
constipation: management: nonpharmacologic treatment for toddlers & preschoolers | increase water intake; decrease juice intake; whole fruits instead of juice; daily fiber intake=child's age +5 | |
nonpharmacologic treatment for all over 5 yr | increase daily fiber intake (age 3-15)=age+5 ; adults=20-35 g/day; increase fluid intake (water) adults =2L/day; physical exercise; bowel training/behavior modification | |
treatment: nonretentive encopresis | increase child's responsibility; stop pressure on child regarding defecation | |
constipation:when start pharmacologic tx | after month of nonpharmacological tx | |
constipation: pharmacologic tx: children | lactulose, sorbital, Miralax; mineral oil orally > 1yr; home colonic clean out with high dose miralax or repeated dose magneium citrate; surfactants to soften stool (docusate sodium) | |
constipation: pharmacologic tx: adults | hydrophilic colloids/bulk forming agents: psyllium, methylcellulose, polycarbophil; surfactants to soften stool-docusate sodium for short term use; osmotic laxatives such as magnesium hydroxide suspension, magnesium citrate, sodium phosphate enema | |
Lubiprostone (Amitiza) | treat chronic constipation in adults | |
management for constipation with fecal impaction | remove impaction with sodium phosphate enema over 2 days; begin long term therapy with mineral oil, lactulose; treat for 3-6 months along with nonpharm tx; follow up every 2 month after impaction for 6months | |
constipation: when to consult, refer, hospitalize | GI referral-tx failure, stool positive for occult blood, symptomatic >50 yr old; children-failed disimpaction; surgeon-obstruction | |
functional causes of constipation | poor dietary intake of fiber & fluids, behavioral habits such as change in environment with travel or schedule, sedentary lifestyle | |
encorpresis | fecal soiling or staining underwear after 4 years of age either due to retentive constipation or other factors (ie. resistance to toilet training) |